Implications of national tax policy on local pharmaceutical production in a southwestern state nigeria - qualitative research for the intersection of national pharmaceutical policy on health systems development.

BACKGROUND: Universal access to quality and affordable medicines is one of the targets of the Sustainable Development Goals (SDGs). Access to essential medicines is defined as the availability of medicine at an affordable price in public and private health institutions including retail pharmacies in the proximity of less than an hour from the home of the population. The dependence on importation to meet the drug needs of an expanding population has implications on the growth of the local pharmaceutical industry, availability, and affordability of essential medicines in the country. This study aims to understand the dynamics of tariffs and tax policy on local drug production in the pharmaceutical industry in Nigeria. METHODS: This was a qualitative study involving the use of Key Informant Interviews (KIIs). A total of 15 stakeholders were interviewed. Interviews conducted were analysed thematically. The data generated were analysed using Atlas.Ti version 8.2. RESULTS: Assessment of the pharmaceutical industry sub-sector underscores myriads of challenges facing the industry and explains why the pharmaceutical industries in Nigeria are performing sub-optimally. Key stakeholders in the sector expressed concern about the fact that substantial percentage of drugs consumed in Nigeria are imported. Local manufacturers are underperforming due to several factors. Some highlighted factors were unfriendly tax environment, high cost of production, infrastructural deficit, low patronage from the government, and lack of access to low-interest rate loans. However, tax incentives and tax cuts are proven strategies to encourage and facilitate the growth of entrepreneurs in the pharmaceutical industry. CONCLUSIONS: Stakeholders' perspective of implications of the tax environment on the pharmaceutical sector of Nigeria revealed the unfriendliness of the government policy to local manufacturers. Although the checklist for availability and prices of essential medicines in Osun state, Nigeria revealed that the pre-selected drugs were available in the facilities, the observed prices further affirmed the relative difficulty that is experienced by local manufacturers to compete with imported brands of the same drugs.

Socio-economic factors associated with antenatal care in Nigeria.

There is a dearth of knowledge on how much financial autonomy interacts with affordability and consequently access to ante-natal health care in Nigeria. This study evaluated the relationship between women's financial autonomy and utilization of antenatal care (ANC) services. ANC attendance during pregnancy and the financial autonomy of women aged 15-49 in 42,000 selected households across all 36 states and the FCT, was assessed using data from the 2018 NDHS. Descriptive statistics and bivariate and multivariate logistic regression analyses were carried out and significant predictors were tested at a 95% significance level. The proportion of women considered to have no financial, partial and full autonomies were 63.1%, 32.0% and 4.9% respectively. Living in an urban region was a statistically significant predictor of financial autonomy among women and the odds of financial autonomy increased with the level of education and wealth index. Type of residence and occupation type were also significant predictors of ANC utilization. Full financial autonomy to make financial decisions did not significantly improve the odds of antenatal health care services during pregnancy (OR = 1.03; 95% CI: 0.87 - 1.22). Other factors such as education, employment and wealth index of the women were more significantly associated with antenatal care attendance. A call for improved educational facilities and wealth creation schemes at national and sub-national levels of government is necessary to improve ante-natal care utilization in health care facilities.

Housing type and risk of malaria among under-five children in Nigeria: evidence from the malaria indicator survey.

BACKGROUND: Malaria remains one of the major causes of morbidity and mortality among under-five (U5) children in Nigeria. Though different environmental factors have been assessed to influence the distribution and transmission of malaria vectors, there is a dearth of information on how housing type may influence malaria transmission among U5 children in Nigeria. This study assessed the relationship between housing type and malaria prevalence among U5s in Nigeria. METHODS: A cross-sectional analysis of the nationally representative 2015 Nigeria malaria indicator survey data was done. A representative sample of 8148 households in 329 clusters was selected for the survey. Children aged 6-59 months in the selected households were tested for anaemia and malaria using the rapid diagnostic test (RDT) and the microscopy. Data were analysed using descriptive statistics, Pearson Chi square (χ2) and logistic regression models at 5% level of significance. RESULTS: The odds of malaria infection was significantly higher among older children aged 24-59 months (aOR = 4.8, CI 2.13-10.99, p < 0.001), and children who lived in houses built completely with unimproved materials (aOR = 1.4, CI 1.08-1.80, p = 0.01). Other predictors of malaria infection include living in a rural area (aOR = 1.5, CI 1.25-1.91, p = 0.01), ever slept under a long-lasting insecticide-treated net (aOR = 1.1, CI 0.26-4.79, p = 0.89) and in a room not sprayed with insecticide (aOR = 1.2, CI 0.64-2.31, p = 0.56). Children who were malaria positive showed a higher prevalence of severe anaemia on RDT (87.6%) and Microscopy (67.4%) than those who were not anaemic (RDT = 31.6%, Microscopy = 12.9%). CONCLUSIONS: Non-improved housing predicted malaria infection among U5s in Nigeria. Improved housing is a promising means to support a more integrated and sustainable approach to malaria prevention. Education of the Nigerian people on the role of improved housing on malaria protection and empowerment of the public to adopt improved housing as well as overall enlightenment on ways to prevent malaria infection can help to augment the current malaria control measures among U5 children.